การผ่าตัดผ่านกล้องทางรูจมูก...ทางเลือกในการรักษาเนื้องอกต่อมใต้สมอง

Pituitary gland is a small organ located at the base of the brain. It is a gland that produces several hormones released into the bloodstream to regulate the functions of various organs in the body to maintain balance. Examples of these hormones include Prolactin, related to milk secretion; Growth hormone, related to body growth; thyroid hormone; sex hormones (FSH, LH); adrenal gland hormones (ACTH, Cortisol). If a patient has a tumor in the pituitary gland, some of these hormones may be produced in excess, while others may be produced less than normal, causing various symptoms.
<h2 style="color: #008080;">Warning signs of “Pituitary gland tumor”</h2>
<ul>
<li>If Prolactin is high, women may experience milk discharge and absence of menstruation, while men may have enlarged breasts and reduced sexual desire.</li>
<li>In cases where Growth hormone is high, the patient&#8217;s body will be much taller and larger than normal if the disease occurs since childhood. If it occurs after the body has stopped growing, changes will be seen only in the structure of the face, hands, and feet, which will become larger.</li>
</ul>
Additionally, if a pituitary gland tumor is left untreated, it will continue to grow and press on the optic nerves, causing vision loss up to blindness. It can also spread and compress other parts of the brain.
<h2 style="color: #008080;">Diagnosis and cause investigation 
</h2>
Doctors will take a medical history, perform a physical examination, and confirm the diagnosis by performing a brain computed tomography scan (CT brain) or magnetic resonance imaging (MRI brain). These will clearly show the boundaries and size of the tumor. Additionally, checking hormone levels in the bloodstream is also useful for diagnosis and treatment.
<h2 style="color: #008080;">Treatment guidelines</h2>
<ul>
<li>Medication treatment is mostly used for small tumors that have not yet compressed the optic nerves and is only effective for tumors that produce certain hormones, such as Prolactin, which responds better than others.</li>
<li>Surgical treatment is used when medication treatment is ineffective or the patient cannot continue taking medication, or in cases where the tumor grows and the patient experiences abnormal vision due to the tumor pressing on the optic nerves.</li>
</ul>
<h2 style="color: #008080;">Surgical treatment</h2>
<ul>
<li>Method 1: Surgery through the frontal skull area above the eyebrow using a microscope for magnification. This surgery is suitable for large tumors that have spread to other parts of the brain.</li>
<li>Method 2: Surgery using a microscope for magnification through the nasal cavity or the upper gum through the nasal passage, known as the Transsphenoidal Approach.</li>
</ul>
The advantage of this surgery is avoiding brain tissue surgery as in Method 1, which may cause brain trauma or complications. However, this method is suitable for tumors that are not large and have not extensively spread to the base of the brain.
<ul>
<li>Method 3: Surgery using an endoscopic camera inserted through the nasal cavity. This method leaves no external wounds on the outside of the nose or upper gum as in Method 2. Another advantage is that the endoscopic camera is about 4 millimeters in size and can be inserted through the nostrils close to the tumor area. The surgeon can see clearer and wider panoramic views during surgery.</li>
</ul>
This surgery was pioneered by a Korean neurosurgeon working in the United States and has been developed over nearly ten years. Due to many advantages, this surgery has become popular in European countries, especially Italy, and many places in Japan also use this method. It is expected to become popular worldwide in the future.
In Thailand, this surgery began around 2001. Due to its many advantages, the number of surgeries is expected to increase continuously in the future.
<h2 style="color: #008080;">Advantages of this surgical method are as follows:</h2>
<ol>
<li>No visible external wounds</li>
<li>No surgical wounds in the gums or nasal packing with gauze, allowing patients to breathe more comfortably and eat without affecting the wound</li>
<li>Less postoperative pain</li>
<li>Shorter hospital stay</li>
</ol>
However, this surgical method must be performed in hospitals equipped with the necessary tools, equipment, and personnel. Neurosurgeons will advise and select the most appropriate surgery for each patient. After surgery, some patients may be recommended to undergo radiation therapy to improve treatment outcomes.
&nbsp;
Dr. Theerasak Puenngam 
Neurology and Neurosurgery Specialist 
Brain and Spine Center, Phyathai 2 Hospital

A tumor in the pituitary gland, if left untreated, will continue to grow and press on the optic nerves, causing vision loss up to blindness. Additionally, it can spread and compress other parts of the brain.

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Endoscopic Transsphenoidal Surgery... An Option for Treating Pituitary Tumors

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